1. A Sports Medicine Approach to Overuse Injuries in the Workplace Presented by Jeffrey Pearson, D.O. San Marcos, California www.medicine-in-motion.com

2. Sportsmedicine u Medicine in motion

3. The Industrial Athlete u Applying the principles of sportsmedicine to the evaluation and treatment of injured workers.

5. The Industrial Athlete u Advantages v Faster, more efficient return to participation v enhances self-esteem of injured worker v Team physician concept

7. Humans are machines u Underlying structure u electrical system u plumbing u pulleys u energy plant u thermostat

9. Review of anatomy u bones v joints/synovial linings u ligaments u muscles/tendons v synovial sheaths

11. The Cycle of Overuse Overloading Tissue injury Inflammation Continued activity Pain Rest - healing

13. Overuse: force vs. time u Effects of force (intensity) v jumping from chair to floor v jumping from significant height u acute overuse

14. Overuse: force vs. time u Effects of time (duration) v walking around the block v hiking the Continental Divide u chronic overuse v cumulative trauma

15. Common types of overuse injuries u Tendons v de Quervains tenosynovitis v extensor tendonitis/lateral epicondylitis v rotator cuff impingement u Nerves v carpal tunnel syndrome v cubital tunnel syndrome

16. Common types of overuse injuries u Bone and joints v stress fractures v degenerative arthritis u Connective tissues v plantar fasciitis

17. Grading overuse injuries u Grade I (most mild) v symptoms occur generally only after activity or at night. u May keep hands under pillow.

18. Grading overuse injuries u Grade II v symptoms occur during activity, but do not interfere with performance of tasks.

19. Grading overuse injuries u Grade III v symptoms occur during activity and do interfere with performance.

20. Grading overuse injuries u Grade IV v symptoms so bad unable to use the affected part.

21. Treatment of overuse injuries u General principles v flexibility v strength v endurance

23. Treatment of overuse injuries u Acute phase v PRICES u Protection u Rest u Ice u Compression u Elevation u Support

24. Ice is Nice!

25. Treatment of overuse injuries u Grade I v Reduce intensity or duration of activity by 25%. More diligent stretching. Ice following activity. v Follow the 10% per week rule. Sudden, excessive overtime is a sure-fire recipe for overuse complaints because the workers do not have an opportunity to build up their endurance prior to the extra work. Sudden, excessive overtime is a sure-fire recipe for overuse complaints because the workers do not have an opportunity to build up their endurance prior to the extra work.

26. Treatment of overuse injuries u Grade II v v Reduce intensity or duration of the activity by 50%. v v NSAIAs v v Counterforce bracing v v Consider physical therapy u u flexibility, endurance, eccentric strengthening

27. Treatment of overuse injuries u Grade III "Active" rest: the worker should stop performing the offending tasks, but is allowed to move the affected part for his daily activities. v Physical therapy v Consider steroid injection

28. Treatment of overuse injuries u Grade IV Complete rest of the affected part, usually involving the use of some sort of sling or splint v If all else fails, consider surgical options.

29. Sports Medicine Pearls u Healthy people perform better than sick people. v Difficult to win Super Bowl with team of injured athletes u Athletes perform better when using the right equipment v Difficult to run marathon if shoes too big or too small

31. Sports Medicine Pearls u Training/conditioning v Should progress gradually v Example: return to running program u cycling 45 minutes u walk 2 miles in 30 minutes u alternate jogging/walking u gradually increase speed/intensity/distance – increase by 10% per week maximum

32. Sports Medicine Pearls u Training/conditioning v In the workplace, consider: u Increase duration of a specific task gradually, e.g. an hour/day/week. u alternating tasks/departments every few hours.

33. Sports Medicine Pearls u Work smartly with proper ergonomics v concept of neutrality

35. Sports Medicine Pearls u Maintain flexibility v stretches every 2 hours (approximately) v slow and controlled movements

36. Sports Medicine Pearls u Decrease unnecessary forces to body v footwear u Vibram rubber soles v shock mats

37. Summary u We have only one body/machine that needs to last us for our entire lifetime. u Taking good care of the machine helps to ensure that it will not break down as much and last a long time.

39. Thank you! (And enjoy your stay in San Diego!)